ALL ABOUT YOUR HEALTH!

What is an ulcer?
Imagine the inside of your stomach or intestine is like the wall of a house.

• An ulcer is like a hole in that wall – the injury goes deep, beyond the surface.
• An erosion is a scratch that stays more on the surface and doesn’t go as deep.

How common is it?

• In East Africa, around 15% of people have peptic ulcer disease – that’s about 1 in every 7 people.
• Both stomach and duodenal ulcers are frequent, with duodenal ulcers often more common.

• The duodenum is the first part of the small intestine, directly after the stomach.

• It’s about 20–25 cm long (around 10 inches).
• Shaped like a C or horseshoe.
• It wraps around the head of the pancreas.
• It has four parts: the superior, descending, horizontal, and ascending segments.
• This is where most chemical digestion begins:
  • Stomach acid mixes with food (chyme).
  • Bile from the liver/gallbladder helps digest fats.
  • Pancreatic juice (enzymes + bicarbonate) helps break down carbs, proteins, and fats, and neutralises acid.bicarbonate) helps break down carbs, proteins, and fats, and neutralises

• Ulcers affect men and women, though duodenal ulcers tend to be a bit more frequent in men.

What causes ulcers?

1. Bacteria – Helicobacter pylori

1. • Lives in the stomach lining.
   • Found in most duodenal ulcers and many stomach ulcers.
2. Medicines – especially painkillers
   • NSAIDs (like ibuprofen, aspirin, diclofenac).
   • Risk is even higher if combined with cortisone tablets.
3. Other risks: Smoking, alcohol, stress , age over 65, chronic illnesses (e.g., kidney disease).
4. Rare causes: Hormone problems (overactive parathyroid), very high acid production (Zollinger-Ellison syndrome), severe illness or major surgery (“stress ulcers”).

What’s happening inside the stomach?

• The stomach makes acid to digest food but also protects itself with mucus and good blood flow.
• Ulcers develop when the balance is broken:
  • H. pylori → increases acid + weakens mucus.
  • NSAIDs → block protective prostaglandins.

What are the symptoms?

• Burning or gnawing pain in the upper belly.
• Pain improves with food (duodenal ulcer).
• Pain worsens right after food (stomach ulcer).
• Indigestion, bloating, nausea.
• Serious signs: vomiting blood, black stools.
• Sometimes no symptoms until complications.

How are ulcers diagnosed?

• Stomach endoscopy allows doctors to see inside and evaluate the stomach.
• Biopsies: check for H. pylori and rule out cancer (important for stomach ulcers).
• Blood or stool tests can also detect H. pylori.

How are ulcers treated?

• If caused by H. pylori: Antibiotics + acid blocker (PPI) for 1–2 weeks → “eradication therapy”.
• If caused by medicines: Stop/reduce painkillers, use safer alternatives, take PPIs.
• General treatment: PPIs for 4–8 weeks, avoid smoking and excess alcohol.
• If bleeding: Doctors stop it during endoscopy (clips, injections). Surgery is rare.

Key takeaways for everyday life

• Around 1 in 7 people in East Africa may have an ulcer.
• Most ulcers heal with the right treatment.
• Always test for H. pylori if you have an ulcer.
• Never ignore black stools, vomiting blood, or sudden severe stomach pain → hospital immediately!
• Don’t overuse painkillers like ibuprofen or aspirin. If needed long-term, ask your doctor about protection with PPIs.

Interactive “Check Yourself”

Which of these might raise your risk of an ulcer?
A) Smoking
B) Taking ibuprofen daily
C) Drinking alcohol heavily
D) Helicobacter pylori infection
E) All of the above

Answer: E – all of them!

Definition

Chronic Obstructive Pulmonary Disease (COPD) is a progressive lung disease that makes it hard to breathe properly. It is mainly caused by long-term exposure to harmful substances like cigarette smoke, air pollution, or workplace chemicals. Over time, COPD leads to permanent narrowing and inflammation of the airways, making it difficult for air to flow in and out of the lungs.

Most people with COPD first develop chronic bronchitis. If left untreated, COPD can worsen and lead to lung damage, including emphysema—a condition where the air sacs in the lungs are destroyed, making breathing even harder.

Epidemiology

Global Perspective

COPD is a major global health concern. In 2021, it was the fourth leading cause of death worldwide, responsible for approximately 3.5 million deaths, accounting for about 5% of all global deaths. COPD varies across studies, with estimates ranging from 10.3% to 13.1% globally. Notably, nearly 90% of COPD deaths in individuals under 70 years of age occur in low- and middle-income countries ​ (Source: WHO, PMC and Amboss, PMC)

COPD in Kenya

In Kenya, the burden of COPD is significant.  A study reported that approximately 23% of adult outpatients in Kenya met the spirometric definition of COPD, with 60% of these cases showing no or insignificant bronchodilator reversibility, and 31% classified as severe or very severe. This highlights the substantial impact of COPD on the Kenyan population and underscores the need for targeted public health interventions.​ (Source: WHO, Amboss and PMC)

Signs and Symptoms

COPD develops gradually, and individuals may not notice symptoms until significant lung damage has occurred. Common signs and symptoms include:​

• Shortness of breath (dyspnea): Especially during physical activities.​
• Chronic cough: Often producing mucus (sputum) that may be clear, white, yellow, or greenish.​
• Mucus production especially in the morning
• Wheezing: A whistling or squeaky sound during breathing.​
• Chest tightness: A feeling of pressure or heaviness in the chest.​
• Frequent respiratory infections: Such as colds or the flu.​
• Fatigue: Due to the increased effort required to breathe.​
• Unintended weight loss: In later stages of the disease.​

Other signs and symptoms could be:

 Blue lips and fingernails (cyanosis) due to low oxygen levels in the blood.

 Swelling in the legs (ankle oedema) – A sign that the heart is struggling due to lung disease for instance high pressure in the lung blood vessels.

 Bulging neck veins – Indicates increased pressure in the lungs and heart strain.

 Clubbed fingers and rounded nails (drumstick fingers & watch-glass nails) – Can occur in long-term COPD and may also suggest lung cancer.

 Barrel-shaped chest – Happens in advanced COPD when the lungs become permanently overinflated.

As COPD progresses, symptoms typically become more severe, and individuals may experience exacerbations—episodes of acute symptom worsening.​

Diagnosis

Diagnosing COPD involves a combination of clinical evaluation and diagnostic tests:​

• Medical history and physical examinations:

Medical Doctors will ask about:

• Symptoms – When they occur (day/night), the amount and appearance of mucus, weight loss, fever, or night sweats.
• Smoking history – How long, how much, and whether the person has tried to quit.
• Passive smoking – Exposure to secondhand smoke.
• Allergies or asthma – Any past history of allergic reactions or asthma-like symptoms.
• Frequent lung infections – Recurring colds or sinus infections.
• Daily activities – Any avoidance of physical tasks due to breathlessness.
• Sleep quality – Any sleep disturbances or excessive daytime sleepiness.
• Job exposure – Working with dust, fumes, or gases (e.g., mining, metal industry).

 Physical Examination:

Observation:

🔹 Use of extra muscles to help breathe.

🔹 Cyanosis (bluish skin due to low oxygen).

🔹 Weight loss (cachexia) in severe COPD.

🔹 Barrel chest (sign of advanced emphysema).

🔹 Swelling in legs (signs of heart failure).

Tapping the chest (Percussion):

🔹 Loud, hollow sounds – Due to overinflated lungs in emphysema.

🔹 Diaphragm sits lower than normal and moves less – A sign of lung damage.

Listening to the lungs with a stethoscope:

🔹 Prolonged exhalation – Air gets trapped in the lungs.

🔹 Wheezing and rumbling sounds – Due to airway narrowing.

🔹 Weak or silent breathing sounds – Advanced airway obstruction.

🔹 Crackling noises – Could indicate an infection.

• Spirometry: A key diagnostic test measuring lung function by assessing the volume and speed of air a person can inhale and exhale. A post-bronchodilator FEV₁/FVC ratio of less than 0.70 confirms persistent airflow limitation.​
• Imaging Tests: Chest X-rays or computed tomography (CT) scans can reveal emphysema and rule out other lung problems.​
• Arterial Blood Gas Analysis: Measures oxygen and carbon dioxide levels in the blood, indicating how well the lungs are functioning.

Treatment

While COPD is a progressive disease with no known cure, various treatments can help manage symptoms and improve quality of life:​

• Smoking Cessation: The most crucial step in preventing COPD progression.​
• Medications:
  • Bronchodilators: Relax the muscles around the airways, making breathing easier. They can be short-acting or long-acting.​
  • Inhaled Corticosteroids: Reduce airway inflammation and may be used in combination with bronchodilators.​
  • Phosphodiesterase-4 Inhibitors: Decrease airway inflammation and relax the airways.​
• Oxygen Therapy: For individuals with severe COPD and low oxygen levels, supplemental oxygen can improve quality of life and prolong survival.​
• Pulmonary Rehabilitation: A program that combines exercise training, nutritional advice, and education to help individuals manage their condition.​
• Vaccinations: Regular vaccinations against influenza and pneumococcal pneumonia to prevent infections that can exacerbate COPD.​
• Surgical Options: In select cases, procedures like lung volume reduction surgery or lung transplantation may be considered.​

Early diagnosis and appropriate management are essential to control symptoms, reduce the frequency and severity of exacerbations, and improve overall health status in individuals with COPD.

What is Blood Pressure?

Blood pressure is the force exerted by circulating blood on the walls of the arteries. It is measured in millimeters of mercury (mmHg) and recorded as two values:

• Systolic pressure: The pressure when the heart pumps blood.
• Diastolic pressure: The pressure when the heart is at rest between beats.

According to the World Health Organization (WHO), blood pressure is classified as follows:

A 24-hour blood pressure monitoring test confirms hypertension when the average values reach ≥130/80 mmHg.

Epidemiology of Hypertension: Kenya and Germany

Hypertension is a global health issue, affecting millions worldwide. In Germany, over 50% of individuals over 50 years old have high blood pressure. In Kenya, studies indicate that about 25% of adults have hypertension, though many remain undiagnosed due to limited healthcare access. Risk factors such as obesity, diabetes, and smoking significantly contribute to hypertension in both countries.

Signs and Symptoms of Hypertension

Hypertension is often called a “silent killer” because it may not cause symptoms for years. However, some people may experience:

• Headaches
• Dizziness
• Nosebleeds
• Shortness of breath
• Chest pain
• Vision problems

If left untreated, hypertension can lead to heart attacks, strokes, kidney disease, and other complications.

Types of Hypertension

Primary (Essential) Hypertension

• Accounts for 90% of cases.
• No clear cause, but influenced by factors like age, obesity, salt intake, smoking, alcohol, and stress.

Secondary Hypertension

• 10% of cases, caused by an underlying medical condition, including:
  • Kidney diseases (e.g., glomerulonephritis, polycystic kidney disease)
  • Hormonal disorders (e.g., hyperthyroidism, Cushing’s syndrome, pheochromocytoma)
  • Obstructive sleep apnea
  • Certain medications (e.g., NSAIDs, oral contraceptives, steroids)
  • Substance abuse (e.g., alcohol, cocaine, amphetamines)

Diagnosis of Hypertension

Screening

Blood pressure can be checked regularly from age 18:

General Diagnostic Tests

• Medical history: Family history, lifestyle habits, medication use.
• Physical examination: blood pressure measurement, heart and lung assessment, body weight, waist circumference.
• Laboratory tests:
  • Complete blood count (CBC)
  • Kidney function tests (sodium, potassium, creatinine, eGFR)
  • Blood sugar (fasting glucose, HbA1c)
  • Lipid profile (cholesterol levels)
  • Urine analysis (albuminuria test for kidney damage)
• Additional Tests (if needed):
  • 24-hour ambulatory blood pressure monitoring
  • Electrocardiogram (ECG) to assess heart function
  • Ultrasound or CT scan (if secondary hypertension is suspected)

Treatment of Hypertension

Lifestyle Changes

• Reduce salt intake: high salt consumption raises blood pressure.
• Healthy diet: More fruits, vegetables, and whole grains; less saturated fat and sugar.
• Regular exercise: at least 30 minutes of moderate activity daily.
• Weight control: Maintaining a healthy weight reduces hypertension risk.
• Limit alcohol and quit smoking: both increase blood pressure and cardiovascular risks.
• Stress management: meditation, deep breathing, and adequate sleep.

Medication

Doctors may prescribe antihypertensive medications based on blood pressure levels and risk factors:

• ACE inhibitors (e.g., Ramipril, Lisinopril): Prevent blood vessel constriction.
• Angiotensin receptor blockers (e.g., Losartan, Valsartan): Similar to ACE inhibitors but with fewer side effects.
• Calcium channel blockers (e.g., Amlodipine, Verapamil): Relax blood vessels.
• Diuretics (e.g., Hydrochlorothiazide, Furosemide): Help the body eliminate excess salt and water.
• Beta-blockers (e.g., Metoprolol, Atenolol): Reduce heart rate and workload.

Treatment of Secondary Hypertension

Addressing the underlying cause is crucial. For example:

• Kidney disease: Treat the kidney disorder.
• Hormonal imbalance: Manage endocrine conditions.
• Medication-induced hypertension: Adjust or discontinue the medication.

Conclusion

Hypertension is a serious but manageable condition. Regular screening, lifestyle modifications, and medication (if needed) can help control blood pressure and prevent complications. Early detection is crucial in reducing the risk of heart disease, stroke, and kidney failure, and seeking medical advice from your doctor is vital.

Definition

Heart failure is a clinical syndrome characterized by the inability of the heart to pump blood efficiently to meet the body’s metabolic demands. It results from structural or functional impairment of ventricular filling or ejection, leading to symptoms such as dyspnea, fatigue, and fluid retention.

Classification of Heart Failure

Heart failure can be classified based on different criteria:

1. Based on Ejection Fraction (EF)

• Heart Failure with Reduced Ejection Fraction (HFrEF): EF ≤40%
• Heart Failure with Mid-Range Ejection Fraction (HFmrEF): EF 41-49%
• Heart Failure with Preserved Ejection Fraction (HFpEF): EF ≥50%

2. Based on Clinical Presentation

• Acute Heart Failure: Sudden onset or worsening of symptoms, often requiring emergency care
• Chronic Heart Failure: Progressive condition with long-term symptoms and compensatory mechanisms

3. Based on Affected Cardiac Side

• Left-Sided Heart Failure: Affects the left ventricle, causing pulmonary congestion
• Right-Sided Heart Failure: Affects the right ventricle, leading to systemic venous congestion
• Biventricular Heart Failure: Both ventricles are involved

4. Based on Circulatory Pathophysiology

• Forward Failure: Reduced cardiac output leads to poor organ perfusion
• Backward Failure: Blood backs up into venous circulation, leading to congestion

Epidemiology

• Prevalence: Affects approximately 1-2% of the global adult population, with higher rates in older individuals (>10% in those over 70 years).
• Risk Factors:
  • Hypertension
  • Coronary artery disease
  • Diabetes mellitus
  • Valvular heart disease
  • Cardiomyopathies
  • Chronic kidney disease

Symptoms and Signs of Heart Failure

1. Typical Symptoms

• Dyspnea: Shortness of breath, especially on exertion
• Fatigue and Weakness
• Exercise Intolerance: Reduced ability to perform physical activities
• Peripheral Edema: Fluid retention, particularly in lower limbs
• Nocturnal Symptoms:
  • Orthopnea (dyspnea when lying flat)
  • Paroxysmal nocturnal dyspnea (sudden nighttime breathlessness)
  • Nocturia (frequent nighttime urination)

2. Additional Symptoms

• Cardiac Symptoms: Palpitations, sinus tachycardia, arrhythmias, syncope
• Respiratory Symptoms: Wheezing (cardiac asthma), pleural effusion
• Gastrointestinal Symptoms: Loss of appetite, bloating, nausea, right upper quadrant pain (hepatic congestion)
• Neurological Symptoms: Dizziness, confusion, depression, Cheyne-Stokes respiration
• Skin Symptoms: Cold extremities, pallor, cyanosis (advanced cases)

3. Signs on Physical Examination

• Pulmonary Congestion: Crackles, wheezing, pleural effusion
• Jugular Venous Distension: Due to increased central venous pressure
• Hepatojugular Reflux: Sign of right-sided failure
• Peripheral Edema: Pitting edema in lower extremities
• Ascites: Fluid accumulation in the abdomen (advanced right heart failure)

Diagnosis of Heart Failure

1. Clinical Assessment

• Detailed history and physical examination to identify risk factors and symptoms

2. Laboratory Tests

• Natriuretic Peptides (BNP/NT-proBNP): Elevated in heart failure
• Kidney Function Tests: Assess renal impairment
• Liver Enzymes: Elevated in right-sided failure
• Electrolytes: Monitor potassium and sodium levels
• Thyroid Function Tests: Rule out secondary causes

3. Imaging and Functional Tests

• Echocardiography: Gold standard to assess ventricular function, ejection fraction, and valvular abnormalities
• Chest X-ray: Detects pulmonary congestion, cardiomegaly, pleural effusion
• ECG: Identifies arrhythmias, ischemic changes, or left ventricular hypertrophy
• Cardiac MRI: Used in specific cases to assess myocardial structure
• Coronary Angiography: Performed if ischemic heart disease is suspected

4. Functional Classification

• New York Heart Association (NYHA) Classification:
  • Class I: No limitation in physical activity
  • Class II: Mild limitation; comfortable at rest but symptoms with exertion
  • Class III: Marked limitation; symptoms with minimal activity
  • Class IV: Severe limitation; symptoms at rest

Therapy for Heart Failure

1. Lifestyle and Non-Pharmacological Measures

• Sodium Restriction: Reduces fluid retention
• Fluid Management: Limits daily fluid intake in severe cases
• Weight Monitoring: Detects early fluid accumulation
• Regular Exercise: Improves functional capacity
• Smoking and Alcohol Cessation

2. Pharmacological Therapy

• First-Line Medications (HFrEF)

  • ACE Inhibitors / ARBs/ARNI: Reduce afterload and improve survival
  • Beta-Blockers: Lower heart rate, reduce mortality
  • Mineralocorticoid Receptor Antagonists (MRAs): E.g., Spironolactone
  • SGLT2 Inhibitors: Newer class improving outcomes in HFrEF and HFpEF

• Diuretics: For fluid overload, but do not improve survival

• Ivabradine: For patients with high heart rates despite beta-blockers

• Digoxin: Used in refractory cases or atrial fibrillation with heart failure

3. Device Therapy

• Implantable Cardioverter Defibrillator (ICD): Prevents sudden cardiac death
• Cardiac Resynchronization Therapy (CRT): Improves ventricular function in select cases
• Mechanical Circulatory Support (LVADs): For end-stage heart failure

4. Surgical Options

• Coronary Artery Bypass Grafting (CABG): If ischemic heart disease is the cause
• Heart Transplantation: In refractory end-stage heart failure

Cholangitis: is an inflammation of the bile duct system. The bile duct system is found in the liver and is responsible for the transportation of bile from the liver, or to be precise, from the gall bladder, to the first part of the intestine, which is called the duodenum. Bile juice is made in the liver and stored in the gallbladder. In times of digestion, it’s then transported to the duodenum for the digestion of fats and small cholesterol.

Cholangitis is mostly caused by bacterial infections, and in other circumstances, it could be a chronic infection as the result of an autoimmune condition. An autoimmune condition is when the body identifies its own cells as foreign cells, hence attacking them.

Cholecystitis: this is an inflammation of the gallbladder either due to blockage of the bile duct system with a gallstone or bile sludge. Gallstones are small stones composed of cholesterol that usually form in the gallbladder. Gallstones are a common condition that affects nearly one in every 10 adults.

In medicine, we differentiate:

1. Calculous cholecystitis: this is when the opening of the gall bladder, that is the cystic duct gets blocked by a gun stone or the bile sludge. This blockage then leads to a buildup of bile juice in the gall bladder, hence increasing the pressure inside, which can lead to inflammation.
2. Acalculus cholecystitis: this is a guy bladder inflammation that is not caused by gallstones. This can be caused by severe diseases, operations, or traumas.
3. Chronic cholecystitis: this is a result frequent acute cholecystitis which has been treated using conservative measures like giving antibiotics or healing spontaneously, hence leading to scarring of the gall bladder walls.

There are six major risk factors for the formation of gall stones, which include:

• Being overweight
• Women are more affected.
• Fertile
• Fair meaning white people or people with a fairly bright skin.
• Age: around 40 years
• When it occurs mostly in the family, the risk of other family members getting it is higher.

Cholecystolithiasis: simply refers to having gallstones in the gallbladder.

Choledocholithiasis: this is a term that refers to having gallstones in the bile duct system.

There are some underlying factors that can lead to more frequent building of gallstones. These factors include:

• Disruption of the enterohepatic circulation: This can be caused by diseases such as Crohn’s disease or after recession of the terminal ileum which is the last part of the small intestine which can lead to bile acid loss syndrome.
• Fasting, rapid weight loss, parenteral nutrition, or bariatric surgery
• Haemolytic anaemia: a frequent destruction of red blood cells can lead to increased bilirubin, which can therefore lead to formation of pigment stones from the bilirubin. Bilirubin is a yellow substance that is made after the breakdown of old red blood cells.
• Hyperparathyroidism: The condition that can lead to excessive calcium levels In the bloodstream, therefore contributing to the formation of gallstones out of calcium.
• Caroli syndrome: this is a congenital disease that causes the deletion of the bile ducts in the liver intense can contribute to the formation of gallstones.
• Gilbert syndrome: this is a genetic disorder of bilirubin metabolism that can increase the risk of gallstone formation.
• cystic fibrosis: The condition that leads to a production of a thick mucus layer that can block the bile ducts hence leading to the formation of gallstones.

Let’s have a look at the signs and symptoms:

• Nausea and vomiting
• upper right abdominal pain
• Painful cramps in the right upper abdominal region
• Pain projection in the right shoulder
• Fever
• Jaundice
• Itchiness

-Let look at how are these diseases diagnosed:

• Your doctor will do a physical examination and take your medical history.
• blood tests: Timeline whether the inflammation parameters are high and parameters of gallbladder obstruction, Liver and Pancreas.
• Abdominal ultrasound: this is used to determine the structure of the gallbladder, to see if it is filled with gallstones, and to examine the anatomy of the liver.
• endoscopic ultrasound: this can be used to detect small gallstones in the building system.
• ERCP/MRCP: the former can be used for diagnostic and therapeutic purposes. The latter can only use for diagnostic purposes. This examination is used to showcase the biliary system. In cases of stenosis, the ERCP can be used for therapeutic purposes, for example, dilation of the biliary tracts, removal of gallstones and stenting. (This is a procedure where one can Insert a plastic or metal hollow tube to help relieve obstruction in areas of stenosis).
• CT-Scan: mostly for purposes of better operation planning.
• Abdominal X-Ray: done in suspicion of a hole or tear in the gall bladder.

Now let’s delve into how the above diseases are treated:

• giving pain medications,
• giving medication against cramping
• Not eating or drinking to relieve the strain of the gallbladder.
• Giving the patience fluids directly into the vein to prevent dehydration.
• in cases of high inflammation parameters, giving antibiotics
• Surgery for the removal of the gallbladder may be recommended after initial treatments to prevent acute cholecystitis and for the prevention of potential complications.
• In other instances, surgery may not be recommendable, hence the importance of an ERCP, as stated in the diagnostics above.

So, you may ask yourself, are there ways to reduce the risk of getting cholecystitis?

• Eating a healthy balance today while reducing the number of high cholesterol foods
• Regular exercise reduces the risk of being overweight or obese.
• avoiding Rapid weight loss diets

remember to always seek medical advice.

So, what do we understand by this?

Meningitis is an inflammation of the protective layer membrane that covers the brain and the spinal cord. Anyone can get meningitis, from small babies to older people, and it can be very severe, causing brain and spinal cord damage and long lasting disabilities.

Meningitis is caused by various agents, like bacteria (Neisseria meningitidis, pneumococcal bacteria, and bacteria causing tuberculosis), viruses such as HSV, chickenpox, and other harmless viruses. An infection caused by the HSV, chicken pox viruses, or bacterial meningitis is considered an absolute emergency that needs immediate treatment with antiviral or antibacterial drugs. Meningitis caused by bacteria can be treated by giving antibiotics, depending on the  bacteria that caused the meningitis in the first place, and it should be an antibiotic that can pass through the brain-brain barrier.

Before we delve into the topic, it is important to state that, meningitis can be prevented through vaccination. The meningitis vaccine can be given to children from the age of 12 months and all other age groups, especially those living within the meningitis belt. So, what exactly is the meningitis belt? These are the regions in Africa that are highly affected by meningitis, hence, a recommendation for the meningitis vaccine for kids of the age of 12 months as well as a pneumococcal vaccine.

Meningitis is spread by respiratory secretions through sneezing, coughing or kissing. In some cases, we do have meningitis carriers who can spread the infection yet they don’t suffer from it.

Children are mostly affected by bacterial variants, for example, the pneumococcal variant, which is also the leading cause of pneumonia.

What are some of the signs and symptoms of meningitis?

• Headaches
• high fever
• nausea and vomiting
• irritability to light
• confusion
• seizures
• paralysis
• Drowsiness or unresponsiveness
• stiff neck
• a rash that does not fade

The symptoms do not appear in any order and to some extent, some patients do not show any of the of the signs or symptoms stated above.

The incubation period for bacterial meningitis is around 2  to approximately 4 days but can also extend to 10 days. It is very important to recognise bacterial meningitis at an early stage and begin with antibiotic medication, as it is crucial because it can quickly end in death within hours or days.

The incubation period for viral meningitis is around 2 to 14 days. It mostly begins acutely, lasting a few hours to a few days. HSV or chickenpox virus caused meningitis, also needs early therapy with antiviral drugs. Other less harmless viruses that cause meningitis can heal by themselves after a couple of days to weeks. But since we cannot differentiate which viral infection or bacterial infection is causing meningitis, it’s always advisable to seek medical advice.

Let’s delve into the diagnosis of meningitis

• clinical examination through your physician
• inspection of your skin
• examination of the meningitis sign
• blood tests and microscopic examination of a blood stain
• Lumbar puncture to collect cerebrospinal fluid for microscopic examination
• in some cases, a CT-Scan can be necessary before the lumbar puncture. This is important in situations where symptoms such as unresponsiveness, loss of consciousness neurological symptoms that show suspicion of intracranial pressure signs are present.

So how do you treat a meningitis?

• Early antibacterial treatments
• supplementing the treatment with the antiviral treatments by suspicion of viral meningitis
• cortisone in cases of intracranial pressure suspicion
• supportive therapy such as
• giving paracetamol or ibuprofen for pain or fever’s
• Therapies for seizures in cases where epileptic seizures have been reported.
• giving blood thinners in cases of septic thrombosis

Exposed people to those affected with bacterial meningitis are also given a prophylactic antibacterial medication to help reduce the Spread.

It is crucial to always begin an early antibacterial or antiviral therapy because if meningitis is not treated properly or early enough it could lead to severe long-term problems such as:

• Hearing or vision losses
• problems with memory and concentration
• recurrent seizures afterwards
• problems with coordination, movement, and balance
• loss of limbs due to necessity of an amputation of affected limbs

Always seek medical advice and remember prevention is better than cure, so do get vaccinated as well as your children.

Cancer of the cervix happens when normal cells in the cervix change into abnormal cells and grow out of control. Most people whose cervical cancer is found and treated early do very well. The cervix is the bottom part of the uterus, where it meets the vagina. The cervix is composed of two main types of cells. The outer layer of the cervix is covered with cells called squamous cells. Squamous cell carcinoma of the cervix is the name for a cancer that affects these cells. The cervix also includes glandular cells, which line the canal of the cervix that leads into the uterus. These cells can also become cancerous; when they do, they are called adenocarcinoma of the cervix. Although they arise from different types of cells, squamous cell carcinoma and adenocarcinoma of the cervix are treated similarly in the early stages.

Risk Factors

Most cervical cancers are caused by infection with a virus called human papillomavirus. HPV is spread by direct skin-to-skin contact, includi ng sexual intercourse, oral sex, anal sex, or any other contact involving the genital area (eg, hand-to-genital or mouth-to-genital contact). HPV infection can also cause a noncancerous condition called condyloma, which is caused by genital warts.

HPV infection is very common. Approximately 75 to 80 percent of sexually active adults will acquire a genital HPV infection before the age of 50. There are many types of HPV, and these affect different areas of the body. Most HPV infections are temporary because the body’s immune system effectively clears the infection.

Risk factors for cervical cancer include:

• Smoking tobacco
• Increasing number /constant change of sexual partners. The greater your number of sexual partners and the greater your partner’s number of sexual partners, the greater your chance of getting HPV.
• Early sexual activity. Having sex at an early age increases your risk of HPV.
• Bad sexual hygiene
• Other sexually transmitted infections.
• A weakened immune system, e.g HIV/AIDS
• Genetic prädisposition
• Exposure to miscarriage prevention medicine. If your parent took a medicine called diethylstilbestrol, also known as DES, while pregnant, your risk of cervical cancer might be increased. This medicine was used in the 1950s to prevent miscarriage. It’s linked to a type of cervical cancer called clear-cell adenocarcinoma.

Symptoms

Typically, cervical cancer develops slowly over several years. In some cases, the cancer does not cause any symptoms, while in others, it causes abnormal vaginal bleeding or discharge. This can include vaginal bleeding between menstrual periods, bleeding after sex, or bleeding after menopause. This bleeding may be spotting or heavy bleeding.

Other symptoms may include:

• Menstrual bleeding that is heavier and lasts longer than usual.
• Watery, bloody vaginal discharge that may be heavy and have a foul odor.
• Pelvic pain or pain during intercourse.

Diagnosis

Pap testing and human papillomavirus (HPV) testing are commonly used together to screen for cervical cancer. If a Pap test shows abnormal cells, further testing is essential, as treatment of abnormal cells of the cervix can prevent cervical cancer. A biopsy of the cervix involves removing a small piece of tissue from the cervix. The biopsy is performed during an office visit using a procedure called colposcopy. The colposcope, which is similar to a large magnifying lens, magnifies the view of the cervix. This allows the clinician to better see the location, extent, and degree of cervical abnormalities that may not be visible with the naked eye alone.

The tissue obtained during the biopsy is examined with a microscope to see if cervical cancer cells are present. In some cases, more of the cervix will need to be removed for biopsy; this is done through a procedure called cervical conization or a cone biopsy. This can be done either in the operating room by a surgeon using a scalpel or in the office using a loop electrosurgical excision procedure (LEEP). LEEP is performed with a device that uses an electric current to remove a piece of the cervix. You will usually get the results of the biopsy one to two weeks after the biopsy is done.

CT-scan or MRI of the Pelvis Region: to determine spreading of the tumor to other organs or regions of the body.

Treatment

Cervical cancer can be treated in different ways:

• Surgery: Some cases of cervical cancer are treated with surgery to remove the cancer. Different types of surgery can involve:
• Removing the cervix, uterus, and upper part of the vagina is called a “radical hysterectomy.”
• Removing all or part of the cervix but leaving the uterus in place—this surgery is done only in special situations.
• Radiation therapy: Radiation kills cancer cells.
• Chemotherapy: Chemotherapy is the medical term for medicines that kill cancer cells or stop them from growing. People with cervical cancer usually receive chemotherapy at the same time as radiation therapy.

Prevention

Cervical cancer can be prevented through:

• HPV Vaccination.
• Routine Pap tests.
• Practicing safe sex.
• Proper Hygiene
• Avoid cigarette smoking.

Pneumonia

Pneumonia is an inflammation of the lungs that is mostly caused by bacterial infections but can also be caused by viral infections. It is the most common reason for deaths in developing and in industrial nations.

In Kenya, pneumonia is responsible for approximately one in five children’s deaths. It claims approximately 8,000 to 10,000 children’s lives annually.

Pneumonia takes about two to four weeks before healing. For small children and older people people with lung and heart conditions, the infection will take longer and even probably require hospitalization due to the severity of their conditions.

As mentioned earlier, pneumonia is caused by vectors such as bacteria and viruses, and in patients with a reduced immune system, pneumonia can also be caused by fungi.

Some of the factors that increase susceptibility to pneumonia infections include:

• age factors such as young babies and older people
• seasonal factors like rainy and cold seasons
• Prior medical history such as asthma in COPD (chronic obstructive pulmonary disease),

Pneumonia can be categorized into:

• community-acquired pneumonia: the most common bacteria are pneumococcal, and Haemophilus influenza, others include: Chlamydophila pneumococcal, Mycoplasma pneumococcal, Legionella, Staphylococcus aureus, and Mycobacterium tuberculosis.

-Viruses such as: Influenza, RSV, and Corona Virus

• Hospital-acquired pneumonia: the most common bacteria for these are Pseudomonas aeruginosa and Staphylococcal.
• Pneumonia on patients with a reduced immune system.

mostly caused by minor bacteria and fungi

• Neonatal Pneumonia

Let’s look at signs and symptoms of pneumonia:

• Fever
• Coughing up yellow or green mucus
• Chest pains and pains while breathing
• Aching of the body, joints and headaches
• Exhaustion
• Loss of appetite
• Wheezing while breathing
• Confusion and hallucinations in older patients or due to certain viral infections like influenza

Now that we know the signs and symptoms to look out for, let’s dive into how we diagnose pneumonia:

• Clerking: this is when the doctor asks general questions about your cough, including when the symptoms started and any prior medical history
• the doctor checking for signs like strenuous breathing and blueness of the lips and tongue, this is due to less oxygen intake in the lungs.
• The doctor will do a physical examination using his stethoscope to determine the different sounds of the lungs while breathing
• Blood tests: this helps to determine between a viral and a bacterial infection. In the case of a bacterial infection, the white blood cells and inflammation parameters are mostly high. In the case of a viral infection, the white blood cells and inflammation parameters will be normal or just very slightly elevated. In other cases, one could have both a viral and a bacterial infection, this is what you would call a superinfection in medical terms.
• X-ray: this helps to determine where exactly the pneumonia is located; for example, it could be on both sides of the lungs or just on one side.

Now that we know the different diagnostic steps, let’s have a look at how he treats pneumonia.

• Bacterial infections are always treated with antibiotics.
• Viral infections do not require antibiotics. Mostly, this kind of pneumonia just requires anti-inflammatory treatment with medications such as Ibuprofen, and paracetamol, and enough fluid intake.
• In case of a superinfection with a bacterium and a virus, antibacterial therapy will be required.
• In case of a fungal infection, antifungal therapy is required.

Please note that not all kinds of pneumonia require antibiotics, hence the need to draw blood to differentiate between a bacterial, viral, or fungal infection. This is crucial to avoid the high rise of resistance in antibiotic therapies.

We do say prevention is better than cure, so how can we reduce the frequency in which pneumonia occurs in our general population? The main method of pneumonia prevention, especially in small children and older patients is vaccination.

-small babies and children can be vaccinated against Haemophilus and pneumococcal disease at the age of two months. Older patients as well as patients with a reduced immune system can also prevent the severity of pneumonia by getting vaccines against the named bacteria above.

For more medical gems, keep at Doki’s Advice.

This is a malignant tumour found in the lining of the large intestines up to the rectum.

The large intestine is known for its role in the digestive system to absorb water and remove waste from the food we eat.

Colon and rectal cancer mostly occur at older age, but by a particular number of people who have certain gene mutations, this cancer can occur at an early age, for example, at 30 without them realising it.

Colorectal cancer is the third most common cancer in the world and the second leading cause of death globally.

According to the data required from Globocan, there were an estimate of 1,354 new cases and 937 deaths from colorectal cancer in Kenya in 2018. Other data sources have noticed that there is a rise in colorectal cancer cases in Kenyan rural areas and that it is the fifth most common cancer in sub-Saharan Africa.

Let’s delve into factors that increase the risk of colorectal cancer:

• Genetic Factors:
  • Such as familial disposition
  • Familial polyposis syndrome: Families with this syndrome tend to have the growth of many polyps along the large intestines at a very young age. These polyps can with time, go through genetic mutations, causing them to be cancerous and hence leading to early-stage colorectal cancer. To note, with this syndrome, the growth of polyps can also occur in any part of the intestines.
  • Hereditary nonpolyposis colorectal cancer syndrome: This is also another genetic disease that increases the risk of colorectal cancer.
• Eating habits and lifestyle:
  • Smoking and excessive drinking of alcohol.
  • Obesity
  • Low fibre or high fat diet
  • Red meat or processed meat and foods

-Some protective factors would be:

• Exercise
• Eating foods rich in fibre, vegetables, and less meat
• Maintaining healthy weight

Now that we know the risks and protective factors, let’s have a look at the signs and symptoms of colorectal cancer:

• Most of the time, there are no characteristic early symptoms
• A constant change of bowel movements from Obstipation and diarrhoea
• Rectal bleeding: this can either be visible blood or non-visible, meaning it can only be detected by doing a faecal occult blood test.
• Persistent abdominal discomforts such as cramps passing gas or pain
• Unexplained weight loss within a short period of time
• Feeling like the bowl isn’t completely empty even after passing stool.
• Fatigue and weakness
• Unexplained Anaemia

So how do we diagnose colorectal cancer?

• A basic diagnostic is performing a digital rectal examination from your doctor. This is used to detect palpable Tumours just near or around the rectal and anal regions.
• Complete colonoscopy with biopsy: This is an examination of the whole large intestine with the possibility of taking biopsy samples to pathologically test the sample for tumours type.
• Rectoscopy for rectal cancer diagnosis.
• CT-Scan for staging purposes: is the tumour metastasized? if yes to what organs.
• Lab tests for tumour markers such as CEA as a control value especially while doing chemotherapy and years after remission.
• MRI-Scan: mostly in regard of rectal cancer.

After a proper diagnosis of colorectal cancer the next step would be to discuss with your oncologist and surgeon what the individual therapy plan will look like. This is determined by factors like

• how physically fit is the patient prior to therapy,
• is the patient eligible for surgery or not,
• size of the tumour
• is the tumour only at one spot or several spots in the bowel?
• does the tumour have certain genetic changes?
• Is prior Radio-chemotherapy necessary or not.

-Let have a look at the different therapy options

• Surgery: This is the option for tumours that are just locally on one spot or multiple tumours localised on the same segment of the large intestine. Some tumours could have spread to the liver but could still be operable when the metastasis is either singular or multiple but localised in the same area. Such factors would have to be considered by your surgeon.
• Chemotherapy: Some Tumours could be so large that prior chemotherapy is required to shrink them to an operable size.
• Radiotherapy: This is mostly done on rectal cancers since colon cancers are insensitive to radiation.

Which therapy regime each patient needs depends on some of the factors noted above. Some may need a Stoma bag after an operation. This will also be discussed with you during the planning stage for the therapy needed.

As always, seek medical advice and keep it Doki’s Advice for more info gems.